Montanino-Oliva M, Metzger D A, Luciano A A
Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, USA.
Fertil Steril. 1996 Mar;65(3):650-4. doi: 10.1016/s0015-0282(16)58169-2.
To evaluate the efficacy of a commonly used progestogen, medroxyprogesterone acetate (MPA), in the prevention of postoperative adhesion formation.
A double-blind, controlled study evaluated the efficacy of MPA to reduce postoperative adhesion formation and compared it with other adjuvants and controls in a rat model.
Animal Care Facility of an academic research setting.
Seventy-five Sprague-Dawley female rats randomly divided into five groups.
Three weeks before surgery, the animals from each group were administered an IM injection of one of the following regimens: [1] 15 mg MPA; [2] both 15 mg MPA and 0.75 mg leuprolide acetate (LA); [3] 0.75 LA; or [4] and [5] comparable volumes of sterile saline. A standardized surgical trauma was inflicted in all animals. Before abdominal closure, 2 mL of Ringer's Lactate was instilled in the abdominal cavity of all groups except group 5 (controls). Three weeks after surgery, the rats were killed and the adhesions were scored on a scale of 0 to 3 according to their size, thickness, and vascularity.
Postoperative adhesions.
The preoperative administration of MPA resulted in the least number and the least severe adhesions. The combination of LA and MPA did not reduce postoperative adhesion formation. Both Ringer's Lactate and LA reduced postoperative adhesions but not to the same extent as MPA.
The preoperative administration of MPA in our laboratory animal model results in the most significant reduction of postoperative adhesion formation. This action of MPA may be mediated by the induction of both a progestational and a hypoestrogenemic milieu. However, the ultimate role of MPA in a clinical situation requires further investigation.
评估常用孕激素醋酸甲羟孕酮（MPA）预防术后粘连形成的疗效。
一项双盲对照研究在大鼠模型中评估MPA减少术后粘连形成的疗效，并将其与其他佐剂和对照组进行比较。
学术研究机构的动物护理设施。
75只Sprague-Dawley雌性大鼠随机分为五组。
手术前三周，每组动物接受以下一种方案的肌肉注射：[1]15mg MPA；[2]15mg MPA和0.75mg醋酸亮丙瑞林（LA）；[3]0.75mg LA；或[4]和[5]等量的无菌生理盐水。所有动物均造成标准化手术创伤。除第5组（对照组）外，所有组在关闭腹腔前向腹腔内注入2mL乳酸林格液。术后三周，处死大鼠，根据粘连的大小、厚度和血管化程度按0至3分进行评分。
术后粘连情况。
术前给予MPA导致粘连数量最少且程度最轻。LA与MPA联合使用并未减少术后粘连形成。乳酸林格液和LA均能减少术后粘连，但程度不如MPA。
在我们的实验动物模型中，术前给予MPA可最显著地减少术后粘连形成。MPA的这一作用可能是通过诱导孕激素和低雌激素环境介导的。然而，MPA在临床情况下的最终作用仍需进一步研究。
